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Some Predictors of Psychiatric Consultation in Nursing Home Residents

Received March 7, 2003; revised October 22, December 3, 2003; accepted January 6, 2004. From the Mental Health Service Line, Veterans Affairs Maryland Health Care Center (JF,ASM,BK,DL,PER); the Veterans Affairs Capitol Network Mental Illness Research Education and Clinical Center (PER); the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine (ALGB,JM); the Department of Psychiatry, University of Maryland School of Medicine (AR); and the Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill (SZ). Send correspondence to Paul Ruskin, M.D., Mental Health Service Line (116/MH), Baltimore VAMC, 10 N. Greene St., Baltimore, MD 21201. e-mail: Paul.Ruskin{at}med.va.gov
© 2004 American Association for Geriatric Psychiatry

Objective: Despite the high rate of psychiatric disorders in nursing homes, research indicates that psychiatric consultation is requested infrequently. The authors sought to determine the rate of psychiatric consultation in a nursing home population and to assess what factors were related to a consultation request. Methods: Subjects were recruited from a stratified random sample of 59 nursing homes across Maryland. All new admissions age 65 years and older from September 1992 through March 1995 were eligible for the study. A total of 2,285 subjects were included in the study. Variables examined were factor scores from the Cornell Scale for Depression in Dementia and the Psychogeriatric Dependency Rating Scale (Behavioral Subscale), nursing home characteristics, and whether the resident had a psychiatric consultation within 90 days of admission. Results: Twenty percent of the residents (N=404) had a psychiatric consultation. There was no significant association with demographic variables. Behaviors that triggered a psychiatric consultation included agitation, physical/verbal abuse, wandering, and manic/destructive acts. A psychiatric consultation was also requested when residents displayed anxiety. Surprisingly, depression in retarded and psychotic residents did not trigger a psychiatric consult. Conclusion: As expected, behavioral problems and agitation are common reasons for a psychiatric consultation. However, the resident who is depressed, particularly the quiet or retarded depressed resident, may be overlooked. In this context, it is important for the nursing staff to recognize that lethargy and social withdrawal may be signs of depression, and a referral to a psychiatrist may be in order.

Key Words: Nursing Home Residents • Long-Term Care • Depression • Stroke